It didn’t get much attention during the presidential debates, but the future of federal health care policy is one of the crucial issues that will be decided by Tuesday’s election. The candidates have pledged very different approaches, largely framed around how they will deal with the federal health reform law passed in 2010.

President Barack Obama, of course, plans to move forward with his signature legislation, often called “Obamacare,” that by early 2014 will force a slew of changes in the health care marketplace. Mitt Romney pledges to repeal the law, although exactly what that looks like will depend a great deal on the composition of the Congress elected Tuesday.

Kaiser Health News points out that both sides likely won’t live up to their campaign promises about the health law. Even if Obama wins, the article notes that lawmakers trying to dial back spending could target some of the planned subsidies, such as ones designed to make insurance more affordable for lower income families.

But Romney too is unlikely to follow through on his pledge to completely overturn the law. This blog by Republican pundit David Frum, who previously wrote an endorsement of Romney, was skeptical that outright appeal is possible. Frum noted that Democrats might hold their majority in the U.S. Senate, while also questioning whether Republicans could stomach overturning the more popular provisions of Obamacare.

Much of the most acrimonious rhetoric in the campaign has centered on Medicare, the federal health insurance program for the elderly. But perhaps the starkest differences between Romney and Obama will be how they deal with Medicaid, the program designed to provide coverage for the poor.

The Algiers Community Health Center was photographed in June 2006. Susan Poag,The Times-Picayune archive

This weekend, NOLA.com | The Times-Picayune looked at how Gov. Bobby Jindal’s pledge not to take the Medicaid expansion laid out in Obamacare could impact the network of primary care clinics in this area that has blossomed since Hurricane Katrina.

This article in the Sarasota Herald-Tribune lays out the Medicaid plans. Like Jindal, Florida Gov Rick Scott rejects the Medicaid expansion meant to provide insurance coverage to states’ poorest uninsured citizens. Both Republican governors say the program is too expensive.

Scott says in the Herald-Tribune piece that he favors Romney’s approach of converting Medicaid into a block grant, saying it would give states more flexibility to run their own programs.

However, the article references a recent analysis by the Kaiser Commission on Medicaid and the Uninsured that analyzed a block grant plan and concluded states could see big cuts to how much money they receive from the federal government.

The conservative Heritage Foundation had a skeptical take on the Medicaid expansion, releasing a "state lawmaker's guide" earlier this fall that cautioned the initiative could end up more expensive for states than advertised.

Under the expansion, the federal government would pick up 100 percent of the cost for the first three years, but eventually drop to paying for 90 percent of new enrollees. But the foundation noted that future administrations and Congresses could increase the states' shares.

While Medicaid is less of a political hot potato than Medicare, the reach of the program is wider than many realize. Medicaid ends up subsidizing nursing home stays, including for many formerly middle-class people who depleted their savings at the end of their lives. The New York Times in September looked at Medicaid’s importance to seniors, finding that almost a third of the $400 billion spent by the program is for “long-term” care.